What is a hybrid cardiac surgical procedure?

In recent weeks Wyatt Cornali received hybrid surgery to repair a hole in one of the wall of his heart. In Wyatt’s case it is the wall between the two lower chambers of the heart that had to be repaired. In a previous surgery, a band was also placed around Wyatt’s pulmonary artery to reduce bloodflow to his lungs. This banding had become too tight. The banding was removed and the artery repaired.

The definition for hybrid surgery according to Wikipedia is as follows:

A hybrid cardiac surgical procedure in a narrow sense is defined as a procedure that combines a conventional surgical part (including a skin incision) with an interventional part, using some sort of catheter-based procedure guided by fluoroscopy (or other, e.g. CT or MRI) imaging in a hybrid OR without interruption. A wider definition includes a clinically connected succession of a catheter intervention and a surgical procedure with a time gap.[1][2]

In short both open heart surgery and a catheter-based technique was used on Wyatt, therefore it was a hybrid surgical procedure. The catheter based method was used to deliver a plug to the site of the hole in his heart wall. The plug was then secured and his heart tissue will grow over the plug in due time.

The plug used to close Wyatt’s VSD can be seen second from the right on both pictures.

Here is a closer look:

The neck (narrower part) of the plug is deployed into the hole and it closes it. The wings then secure the plug in place, and the heart tissue grows over it, making it part of the heart.

Wyatt is doing well and he has been released in the meantime.

Wyatt is one of the fortunate cases where he was diagnosed while his mommy was still pregnant with him. This very early warning gave the Cornali family time to prepare as they had to travel from a different province for Wyatt to be born at a hospital who had the resources and knowledge to care for him. If Wyatt had not been diagnosed during his gestational period, his outcome could have been far less rosy.

Wyatt’s story reminds us that ultrasounds are not just for checking gender and growth in terms of weight and size. Ultrasound technology is able to look inside the heart of an unborn child and identify possible abnormalities. There are 6 simple questions that every parent should ask when a doctor is performing an ultrasound:

1. Do you see four chambers in our baby’s heart?
2. Are there two upper chambers (left and right atria) with valves controlling blood flow into the heart?
3. Are there two lower chambers (left and right ventricles) with valves controlling blood flow out to the body (aortic) and lungs (pulmonary)?
4. Do the two valves and vessels (aorta and pulmonary arteries) exit the heart in a crossing fashion?
5. Are the walls between the lower chambers of the heart intact?
6. Is our baby’s heart normal?

If at any point your OBGYN can not answer these questions, then it is best to ask for a referral to a fetal specialist who can give you a second opinion. For more information please email liza@heartkids.co.za or contact our support line on 074 120 0279.